Ancestral Living | Traditional Birthing | Primal Parenting

Folic Acid or Folate + Supplements vs. Whole Foods + Pregnancy Needs

Many women have heard in passing or been told at some point by a care provider that they need to be taking folic acid before they get pregnant or during pregnancy. The standard recommendation by doctors is "400 mcg of Folic Acid every day for childbearing women" (women who are menstruating, whether actively trying to conceive or not). There was a point that so few women were thought to be getting 'folic acid' in their diets naturally, that it became mandatory for food companies to fortify their foods with it (mostly breads and cereals).

The problem really starts at the beginning. Folic acid is the artificial supplemental form of a vital water-soluble B-vitamin called Folate. In actuality, folate is what is needed by childbearing women in pregnancy to help prevent neural tube defects from forming, generally in the first eight weeks of embryonic development, a lack of which causes birth defects such as spina bifeda. On top of that, the real in-take need is higher than 400 mcg/day.

With most other synthetic supplements and artificial vitamins, besides the very problem of being 'synthetic', our bodies do not absorb much of any-- generally only around 10% and the rest is flushed as neon yellow or green urine-- of the supplement once consumed, nor can our bodies typically utilize what it does absorb. The body systems simply do not recognize these foreign, artificial vitamins and minerals. Folic acid is included in that, though we actually tend to absorb more instead of less, but our body doesn't utilize it properly (more below) which is actually linked to health problems, most notably of which is cancer.

Folic Acid vs. Folate

Medical professionals, nutrition experts, and health practitioners frequently mix up the two terms, and many believe that they are essentially the same thing. However, this is untrue and for non-childbearing age women (those in menopause and men, for example), excessive amounts of the synthetic folic acid can be detrimental to their health.

Chris Kresser describes the difference between them best.

"Folate is a general term for a group of water soluble b-vitamins, and is also known as B9. Folic acid refers to the oxidized synthetic compound used in dietary supplements and food fortification, whereas folate refers to the various tetrahydrofolate derivatives naturally found in food.

The form of folate that can enter the main folate metabolic cycle is tetrahydrofolate (THF). Unlike natural folates, which are metabolized to THF in the mucosa of the small intestine, folic acid undergoes initial reduction and methylation in the liver, where conversion to the THF form requires dihydrofolate reductase. The low activity of this enzyme in the human liver, combined with a high intake of folic acid, may result in unnatural levels of unmetabolized folic acid entering the systemic circulation.

Several studies have reported the presence of unmetabolized folic acid in the blood following the consumption of folic acid supplements or fortified foods. Human exposure to folic acid was non-existent until its chemical synthesis in 1943, and was introduced as a mandatory food fortification in 1998."

The Risks of Folic Acid

Though there has been a reduction in Neural Tube Defects (NTDs) since the implementation of food fortification, beverage and dietary supplementation with folic acid, there has been an increase in folic acid-related health problems in exchange. Some of those concerns include:

Causing Cancer

"In patients with ischemic heart disease in Norway, where there is no folic acid fortification of foods, treatment with folic acid plus vitamin B12 was associated with increased cancer outcomes and all-cause mortality. In the United States, Canada, and Chile, the institution of a folic acid supplementation program was associated with an increased prevalence of colon cancer. A randomized control trial found that that daily supplementation with 1 mg of folic acid was associated with an increased risk of prostate cancer."

Impeding Our Ability to Fight Cancer

The presence of unmetabolized folic acid in the blood, mentioned above, is associated with decreased natural killer cytotoxicity. "Since natural killer cells play a role in tumor cell destruction, this would suggest another way in which excess folic acid might promote existing premalignant and malignant lesions" and inhibit the body's natural defense system against cancer.

B12 Deficiency, Decreased Cognitive Ability, & Anemia

Too much folic acid in the diet can potentially mask the signs of B12 deficiency, and folic acid supplementation over 400 mcg/day has been linked to anemia and a faster decline in cognitive ability in the elderly compared to those not supplementing with folic acid.

Folate Deficiency

Folate, also known as B9, has very important functions in the body (both in non-pregnant and pregnant persons; men and women) and is necessary for rapid cell division and growth, the development of red blood cells, and supporting the nervous system. Pregnancy doubles the dietary needs of folate. Folate deficiency is considered one of the most common vitamin and mineral deficiencies in the US and can cause:

anemia

neural tube defects such as spina bifeda and potentially miscarriages

increased cancer risk

an increased risk of cardiovascular disease, stroke, and other health conditions related to elevated homocysteine

Folate deficiency is mostly caused by inadequate dietary intake, but can also be caused by conditions such as pregnancy and lactation that require a higher intake, malabsorption, altered or impeded liver function, and increased elimination of folate. Folate deficiency can also be caused by an excessive amount of Vitamin D. Vitmain D blocks the absorption of folate, which is one of the hypothesized reasons why peoples from regions closer to the equator have darker skin tones as melanin helps block excessive vitamin D manufacturing in the body. Too much UV exposure leads to too much vitamin D which leads to decreased folate which leads to NTDs and possibly miscarriages. Those who are supplementing with Vitamin D should speak to their care provider about their folate intake if planning on becoming or already pregnant.

Folate Supplementation, Whole Food Sources, & Pregnancy Needs

To avoid the risks associated with artificial folic acid supplementation, it is advisable to avoid most packaged/commercial foods, breads, cereals, and other fortified beverages and foodstuffs. Look for 'enriched' or 'fortified' on labels, and 'folic acid' in the nutritional information on packaging to know what to avoid.

Pregnancy Needs

400-600 mcg of folate a day during pregnancy is the bare minimum needed to prevent NTDs. It is recommended when using folate instead of folic acid to get more than the minimum recommendation, and for women planning to get pregnant to consume 800-1200 mcg of folate daily for several months before the start of pregnancy. If you’re pregnant or trying to get pregnant, you may want to supplement with 600-800 mcg of folate per day, depending on your dietary intake. Keep in mind that the recommendations for folate is more than folic acid since it’s not as easily absorbed.

Supplements

Unless you are eating grassfed liver (see this post on how to make your own liver pills at home) and substantial amounts of dark green leafy vegetables on a regular basis, which is of course recommended, you will more than likely need to add a folate supplement. Most multi-vitamin or prenatal vitamin supplements will have 'folic acid' listed. Look for a multi-vitamin or prenatal vitamin that is whole-foods based, does not contain folic acid, and has 'folate' (the whole-food, natural source of 'folic acid') on the label. You also want to look for products that contain the Metfolin brand, or list “5-methyltetrahydrofolate” or “5-MTHF” on the label.

Older women and men do not need to supplement unless their diet is extremely limited. As always look for non-GMO and organic whenever possible and discuss your needs with your care provider before changing or adding dietary supplements.

Food Sources are Best

Despite the risks associated with high levels of folic acid intake, it is well known that adequate folate intake is essential for health. Of course, my number one recommendation is to try your best, whether pregnant or not, to get your needed nutrients through a whole foods diet. Strive to get organic and grassfed whenever possible! This is extremely important not only for avoiding toxic chemical exposure (especially while pregnant as chemicals such as pesticides can cause birth defects), but also because organic and grassfed foods have higher amounts of nutrients in them compared to non-organic and conventionally farmed foods.

Excellent sources of dietary folate include vegetables such as romaine lettuce, spinach, asparagus, turnip greens, mustard greens, parsley, collard greens, broccoli, cauliflower, beets, and lentils. Not surprisingly, some of the best food sources of folate are beef liver and chicken liver, though it is possible for a vegetarian to get a good amount of folate from vegetable sources which is often not always the case (such as with iron). Other good sources of folate include beans/legumes and pastured eggs.

Some whole-food sources of folate number crunching (these are approximate):

It is my hope that this article and the resources provided below have helped you to better understand the difference between Folic Acid and Folate and why Folate is so important. It is also my hope that, though there are decent folate supplements on the market, that the above lists will help you utilize whole foods to provide the majority of your Folate needs. And of course always be sure to talk to your care provider, doctor or midwife before changing or starting any supplements, major dietary changes, etc. especially if pregnant or breastfeeding and always do your own research. Below are sources used in writing this article and further resources for you to utilize.